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Retirement Recognition Request

  1. Creating an account or logging in to Form Center is optional and is not required to submit this form.

  2. Certificate is for:
  3. Requestor Information:
  4. Contact Jill Bronaugh, Public Information Officer, if you have any questions regarding the requested certificate

    jill.bronaugh@ks.gov   (785) 296-3403

  5. **We will only recognize individuals whose retirement date falls within the current Fire Marshal’s tenure of 2012 to present.
  6. ***Please allow two weeks to receive certificate.
  7. Leave This Blank:

  8. This field is not part of the form submission.